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Idaho rates for HCPCS J0642

Injection, levoleucovorin (Khapzory), 0.5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.12 / $1.12 / $1.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.42 / $1.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.34 / $1.34 / $1.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.42
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.56 / $1.89 / $2.54
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.78
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.79 / $2.54 / $4.34
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.71 / $1.71 / $1.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.58